Measuring and Predicting Patient Dissatisfaction After Anterior Urethroplasty Using Patient-Reported Outcomes Measures

Abstract Purpose Subjective measures of success after urethroplasty have become increasingly valuable in postoperative monitoring. The purpose of this study was to examine patient-reported satisfaction following anterior urethroplasty using objective measures as a proxy for success. Materials and Methods Men ≥18 years old with urethral strictures undergoing urethroplasty were prospectively enrolled in a longitudinal, multi-institutional urethroplasty outcomes database. Pre- and postoperative assessment included questionnaires to assess lower urinary tract symptoms (LUTS), pain, satisfaction, and sexual health. Analyses, controlling for stricture recurrence (defined as the inability to traverse the reconstructed urethra with a flexible cystoscope), were performed to determine independent predictors of dissatisfaction. Results Of 433 patients, we found a high rate of overall postoperative satisfaction (89.4%) and a high rate of men who would have chosen the operation again (82.8%) at a mean follow-up time of 14 months. Men with cystoscopic recurrence were more likely to report dissatisfaction (OR 4.96 (95% CI 2.07 – 11.90) and men reporting dissatisfaction had significantly worse uroflowmetry measures (all p < 0.02). Controlling for recurrence, multivariate analysis revealed that presence of pain (urethra OR 1.71 (1.05 – 2.77), bladder OR 2.74 (1.12 – 6.69)), postoperative decrease in sexual activity (OR 4.36 (2.07 – 11.90)) and persistent LUTS (e.g. strain to urinate; OR 3.23 (1.74 – 6.01)) were independent predictors of dissatisfaction. Conclusions Overall satisfaction after anterior urethroplasty is high and traditional measures of surgical success strongly correlate with satisfaction. However, independent of the anatomic appearance of the reconstructed urethra, postoperative pain, sexual dysfunction and persistence LUTS were predictors for patient dissatisfaction.